What's Going On Down There?

So many of us have been brought up to avoid talking about “female trouble” that we won’t even ask the one person who can help—our OB-GYN. When your body is sending red flags, or just plain confusing you, don’t be afraid to ask, say health professionals. The questions can differ as we age. Whether you’re experiencing a minor inconvenience or serious trouble, doctors and other health care providers can offer solutions and reassurance.

In your 20s:
How do I get rid of this odor?

Actually, this is a question for women of any age, but it’s one they’re often embarrassed to ask, says Dr. Robert delRosario of Partners in Women’s Healthcare (www.piwh.com).

If the odor is different for you, it’s time to see the doctor. It could be a yeast infection or shift in bacterial balance. It could be skin cancer, or “it’s misperceived as coming from a vaginal source when it’s actually urethral,” he says.

Bacterial vaginosis, caused by a pH imbalance, is common, says Janet L. Ashby, CRNP, of The Women’s Healthcare Group, York (www.thewhcg.com). “It’s not sexually transmitted, but it is more common in women who are sexually active,” she says. Medicines can restore balance, and probiotics and dietary improvements can help prevent recurrence. Experts agree: douche doesn't help and can even worsen the problem.

In your 30s and beyond:
Do I have to live with urine leaks the rest of my life?

Then, it’s time to take control. When urine leaks limit a woman’s lifestyle, “keeping her from social events or the gym, that’s problematic,” says delRosario. Get help early, when the problem is easier to fix, he says. It’s especially important to maintain workout routines to avoid other health problems, says Ashby.

Weight loss can help lessen incontinence, says delRosario. He advises doing Kegel exercises with an empty bladder, holding the muscles for ten seconds, eight to ten times a day. Ashby suggests physical therapy that teaches patients “which muscles to engage and which to relax. That makes a big difference.” If leaking persists, “it’s an easy fix,” she says. Testing can pinpoint the extent of the problem, and a safe outpatient procedure—no need to fear horror stories about bladder slings—can help support the urethra.

In your 40s:
Why do my periods become unpredictable?

In her 40s, a woman may go two or three months and then have heavier-than-usual periods, but menstruation shouldn’t seem hemorrhagic or cause lightheadedness, says delRosario. Consistent bleeding requiring protection between periods or bleeding after intercourse are also “hallmarks where someone should be evaluated” for underlying causes, he says.

Don’t stop birth control when periods become irregular, says Ashby. “Just because a woman’s not ovulating every month, it’s not the time to pay Russian roulette with birth control.” Stress also impacts the regularity of periods, and “when we’re in our 40s, we have kids in the teens, so that’s a lot of stress,” she says. Medications can help lighten the flow. For women who know they’re done having children, “a wonderful thing called ablation” alters the lining of the uterus for lighter periods or none at all.

In your 50s:
Is pain during intercourse normal?

“Sex should be a pleasurable thing,” says delRosario. “It shouldn’t be accompanied with pain.” And yet, many women hesitate to ask about pain during intercourse. It could be caused by a thinning and stiffening of the vaginal lining. Or it could be a sign of vaginal infections, tumors, or prolapse, says delRosario. That’s why he needs to know where the pain manifests, whether it’s the vagina, bladder, rectum, or intestines.

Pain caused by the vaginal thinning that can come with menopause is “a very curable thing,” he says. Localized vaginal estrogen or oral tablets are safe and effective. Use of water-based over-the-counter lubricants during sex can ease discomfort.

“You don’t have to live with it,” says Ashby. “There’s definitely help.”